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Re: Gestational age discrepancy???From: William D. McIntosh, MD (anonymous@obgyn.net)Tue, 27 Apr 1999 15:30:41 -0500 (CDT)
At Tue, 27 Apr 1999, KH wrote: > >I will try to make this as brief as possible, and would really >appreciate any thougts on my current problem. > >History: 28 years old, pregnant w/ LMP of Jan 21/99. This info makes me >13 weeks, 5 days pregnant, or 11 wks - 3 days gestation. > >Here's my concern: At last visit, Midwife diagnosed uterus large for >dates (discrepancy of about 2 - 3 weeks). Had ultrasound today, and >ultrasound showed one fetus (there was a suspicion of twins) with an >approximate age of 14 weeks, 2 days. > >Why I question this finding: >1) HCG level on Feb. 19 was 215 HCG. This is right in line with a LMP >of Jan. 21, but severely low for a LMP of Dec. 25/98 (my previous >cycle). If pregnancy occured this cycle (12/25/98) that would currently >place me at 17 weeks, 4 days or a gestation of 15 weeks, 2 days. > >2) Menstruation - LMP was 01/21. This was a full 7 day period with >heavy flow and severe cramping (Endometriosis) > >3) Pregnancy symptoms - did not have any symptoms (i.e.: sore breasts) >until Day 28 of my last cycle (01/21) > >4) Loyal use of fertility detection tools including BBT, OPK, and >Cervical Mucus. All use of these tools in the 01/21 cycle were as >expected, including a triphasic temperature shift, and high temperatures >for 18 days. OPK showed a clear surge on Day 15 and 16 of cycle. CM >was eggwhite as expected on Days 12 - 15 of my cycle. Timed intercourse >appropriately, and there was nothing unusual with my cycle. > >Based on this data, what is the chance that my baby was conceived the >cycle before? What else could cause a baby to be large for dates? I am >really worried, and would very much appreciate your thoughts on this >matter. > >-- >Thank you, > >Kimberly > There is virtually no chance that you conceived the cycle before. The error range of an U/S at 13-14 weeks is at least 5 days +/-, so your baby is exactly where he/she is supposed to be. Estimates of uterine size are notoriously inaccurate, so don't let that concern you. Enjoy your pregnancy. It sounds as if everything is as it should be. In short, your U/S confirms your EDC established by LMP, which incidently aligns with all your other indicators. That's as good as it gets. We typically avoid any mention of fetal age. The primary reason for this is that we don't know it, there being no objective indication. Remember, it is not necessarily the same day as the act of intercourse that results in pregnancy. Gestational age (by convention defined as the number of completed weeks from the LMP) is what everyone uses for all references to the pregnancy, so as to avoid any potential for confusion. You know and I know that the baby is 2 weeks younger than the gestational age, but that is the convention that we use for all pregnancy references, so that we are all singing from the same hymnal. All U/S reports use gestational age (weeks from the LMP) as part of that convention. Therefor, you are 13w5d by LMP, and 14w2d by U/S. That is well within the range of normal for this gestational age. Good luck!
-- William D. McIntosh, MD Clarksville, TN
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